In Indonesia, building confidence in vaccines
How health workers are overcoming geographic challenges and some initial scepticism.
The sun had just risen on a Sunday morning in August as Irwan Hakim, a community clinic nurse, strode through the streets of Kerayaan, a remote village in Kalimantan, the Indonesian part of Borneo.
With a megaphone pressed to his mouth, Irwan broadcast his message: Immunize your children today.
By 8:30 a.m., 381 children aged 5–12 years and their parents had heeded his call and gathered at the Rusung Raya Public Primary School for vaccines against potentially deadly diseases, such as measles and rubella.
“The turnout is usually not this high,” Irwan said, surveying the front yard of the school where the children and their families assembled. “This morning is an exception.”
The major reason for this success is efforts by Irwan and a network of nurses, midwives and traditional birth attendants who work closely with the community to build trust, dispel myths and encourage parents to immunize their children.
Irwan and his network were activated as part of the National Child Immunization Month (BIAN). With support from partners including UNICEF, BIAN campaigns had been launched throughout Indonesia. The goal: to reverse a backslide in routine childhood vaccinations linked to the COVID-19 pandemic.
COVID-19 took a significant toll on routine immunization services for children throughout Indonesia. Full vaccination coverage dropped from 93.7 per cent in 2019 to 84.5 per cent in 2021, according to the Ministry of Health. In part, the drop was caused by disrupted supply chains, regulations that limited vaccination activities and a lack of available health workers.
Nationwide, parents and caregivers were reluctant to bring children to health-care facilities for fear of infection, according to a 2020 survey by the Indonesia Ministry of Health and UNICEF.
In Kerayaan, an area that already had a small health workforce, the virus sidelined many health workers. Vaccines were also not delivered and locations that provide vaccinations were closed. Vaccination has been particularly low in Kerayaan, where only 10 out of 45 newborns were vaccinated as of April 2022. Its remote location is a major barrier.
“It takes about 13 hours by motorized vehicles, ferry and wooden boat to reach Kerayaan from the provincial capital,” said Dr. Suprapti Tri Astuti, head of Kotabaru District Health Office, which oversees immunization services in Kerayaan. “So the pandemic exacerbated this situation.”
In addition to the geographic difficulties, scepticism about vaccines is also common. To address these concerns, the health network turns to traditional healers such as Zulaiha.
Zulaiha was trained by her mother, who was trained by her grandmother. She attends women who are in labour and provides guidance to people who come to her for traditional healing, including incantation and application of herbs.
But she also knows the power of immunization. As part of the BIAN campaign, Zulaiha continued her work going house to house to encourage parents and caregivers to take their children to the health centre for vaccinations.
“I do house visits to get children to be vaccinated,” Zulaiha said. “I explain to their parents, get them to go to posyandu [health post]. I told them to not be afraid. Side effects like fever are normal.”
Thanks to Irwan, Zulaiha and the wider network of which they are a part, nearly 90 per cent of newborns in Kerayaan were vaccinated during BIAN. UNICEF has supported health workers through workshops, monitoring and coordinating with village officials to identify unvaccinated children and encourage families to bring their children for immunization.
“Increasing understanding and awareness of the importance of immunization for children is critical for families and needs to be continuously instilled in the whole community,” Irwan said.
“It is our dream that all children on Kerayaan Island can have the right to live a healthy life free from illness, disability and death from diseases that can be prevented through immunization.”